Basic Information
| Provider Information | |||||||||
| NPI: | 1689981839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHPOINT URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 10TH AVE | ||||||||
| Address2: | CASSIDY HALL | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806395545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703512412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 380 EMPIRE RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800262677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703512412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | DENZEL | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9703512412 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 01320688 | 05 | CO | MEDICAID |